儿童化脓性脑膜炎312例临床分析

Epidemiological study of purulent meningitis of Shijiazhuang from 2013 to 2017

目的了解石家庄地区儿童化脓性脑膜炎(PM)的分布特点、临床特征、主要致病菌、疗效、预后、危险因素情况,提高治愈率,减少并发症。方法采用回顾性临床流行病学方法,收集2013-1至2017-12年连续5年河北省儿童医院收治的312例石家庄地区PM患儿的临床资料,对其临床流行病学及疗效预后进行分析。结果河北省儿童医院共收治PM患儿312例,发病时间3～5月(75/312,24.0%);6～8月(89/312,28.5%); 9～11月(84/312,26.9%);12～2月(64/312,20.5%);城市(132/312,42.3%),县级市(36/312,11.5%),农村(144/312,46.2%)。男性患儿(177/312,56.7%),女性患儿(135/312,43.3%),男女比例1.31:1;其中年龄1月～3月(104/312,33.3%),<3岁(186/312,59.6%)。呼吸道感染是最常见的原发病(185/312,59.3%),临床表现以发热最常见(260/312,83.4%),其次为呕吐(216/312,69.2%),嗜睡(210/312,67.3%);血培养阳性者(67/312,21.5%),以肺炎链球菌(17/67,25.4%),流血嗜血杆菌(11/67,16.4%)常见;脑脊液培养阳性者(43/312,13.8%),以肺炎链球菌(13/43,30.2%)、脑膜炎双球菌(7/43,16.3%)常见。首次脑脊液WBC≥500×10~6·L^(-1)(265/312,85.2%);<10×10~6·L^(-1)(8/312,2.6%)。治愈及好转出院者(272/312,87.2%),自动出院(34/312,10.9%),死亡(6/312,1.92%);患儿年龄<3月及病初抽搐发作是预后不良的危险因素(分别为P=0.002;P=0.033)。结论 2013-2017年石家庄地区儿童PM全年散发,四季发病率无明显差异;发病人群主要是婴幼儿;原发病以呼吸道感染为主;病初以发热最为常见,其次为呕吐及嗜睡;肺炎链球菌是导致该病的主要致病菌;患儿年龄小于3月及初期抽搐发作是预后不良的危险因素;少数脑脊液白细胞正常不能排除本病,发病趋于不典型,加强预防和早期识别尤为重要。

Objective To investigate the distribution, clinical characteristics, main pathogenic bacteria, curative effect, prognosis, and risk factors of purulent meningitis(PM)of Shijiazhuang from 2013 to 2017. MethodA retrospective epidemiological study was used to collect clinical data of 312 children with PM treated at the Hebei Children’s Hospital from 2013-1 to 2017-12, whose epidemiology and outcome were analyzed. Results During the study period, 312 children suffered PM were admitted. March to May(75/312,24.0%);June to August(89/312,28.5%);September to November(84/312,26.9%);December to February(64/312,20.5%);rural areas(180/312,57.7%) and cities(132/312,42.3%);Male(177/312,56.7%)and female(135/312,43.3%). The ratio of male to female was 1.31:1. Younger than 3 months old(104/312,33.3%)and younger than 3 years old(186/312,59.6%). Respiratory infection was the most common primary disease(185/312, 59.3%), and clinical manifestations were most common with fever(260/312, 83.4%), followed by vomiting(216/312, 69.2%), drowsiness(210/312, 67.3%). Blood culture positive in 67 cases(67/312, 21.5%), which were common in streptococcus pneumoniae and haemophilus influenzae;while cerebrospinal fluid culture positive in 43 cases(43/312, 13.8%), which were common in streptococcus pneumoniae and meningococcus. The cerebrospinal fluid examination for the first time(WBC ≥ 500 ×10^6·L^-1)were 265 cases(265/312, 85.2%), and 8 cases(8/312, 2.6%) <10×10^6·L^-1. There were 272 cases(272/312, 87.2%) who were cured or improved, and 34 cases(34/312, 10.9%) were transferred to other hospitals, and 6 cases(6/312, 1.92%) died;ages of children <3 months and early onset seizures were risk factors for poor prognosis(P=0.002;P=0.033). Conclusion Children who were suffered PM in Shijiazhuang were distributed throughout the whole year from 2013 to 2017, which was no significant difference in seasons. The main suffers were mainly infants. The primary disease was respiratory infections. The most common symptom was fever at the beginning of the disease, followed by vomiting and lethargy. Streptococcus pneumoniae was the prime pathogenic bacteria;age of less than 3 months and early seizures were the risk factors for poor prognosis;normal white blood cells of less cases in cerebrospinal fluid can not rule out the disease, which tends to be atypical. It was extremely important to strengthen prevention and early identification.